West Virginia District Service Leadership Program Alumni - Membership Application to Continue Serving the Children of the World
By submitting this application you consent to becoming a member of the West Virginia Kiwanis District through September 30, 2021, and that you will not be responsible for the payment of new member fees, Kiwanis International or West Virginia District dues or fees (some of which will be paid on your behalf), and that on October 1, 2021, should you elect to maintain your membership, you will be responsible for said dues and fees going forward. You may rescind your membership at any time. This application process requires you to have been a member of at least one Kiwanis Service Leadership Program (K-Kids, Builders Club, Key Club, Circle K) at some point in the past. You must be 18 years old to become a Kiwanis member. If you are not 18 at the time of submission of this application, it may be held for you.
Email address *
Power of One
Name *
Your answer
Mobile Phone *
Your answer
Date of Birth *
Please put date of birth including year born
MM
/
DD
/
YYYY
Permanent Mailing Address *
Your answer
Service Leadership Program Alumnus of: *
Your answer
Where Will You Be in September of 2017?
Your answer
If in School which School?
Your answer
What will your address be? (If known)
Your answer
Check the forms of Membership that Interest You (you can update this information at any time) *
Required
Next
Never submit passwords through Google Forms.
This form was created inside of Gaddy Engineering Company. Report Abuse - Terms of Service